September 20, 2019

CDC reports more than 500 lung illness cases linked to e-cigarettes

Daily Briefing

    CDC on Thursday said officials from 38 states and one U.S. territory have reported 530 confirmed and probable cases of lung illness linked to e-cigarettes and vaping products.

    CDC reports more cases of a deadly, mysterious lung illness linked to vaping

    Health care providers this summer began alerting CDC to a mysterious, severe lung illness that appeared to be tied to e-cigarette use and vaping.

    CDC last week reported 380 confirmed and probable cases of lung illnesses. Anne Schuchat, the CDC's principal deputy director, on Thursday said the updated number of 530 confirmed and potential cases of the lung illness linked to e-cigarettes and vaping products includes cases from investigations public officials conducted a number of weeks ago. However, Schuchat said she expects the number of cases to increase further as state officials continue to report new cases in the ongoing outbreak.

    CDC on Thursday also reported two additional deaths believed to be tied to the illness, bringing the total mortality count to eight. The deaths occurred in California, Illinois, Indiana, Kansas, Oregon, Minnesota, and Missouri. They involved patients ranging in age, including middle-aged and older patients, and men and women. CDC noted 72% of cases have involved men, 67% involved adults between the ages of 18 and 34, 17% of cases involved adults ages 35 and older, and 16% of cases involved individuals under 18.

    Cause of new lung illness remains unclear

    FDA on Thursday said it has yet to identify a common factor linking the cases and deaths. FDA's tests have shown the deaths involved patients who used e-cigarettes for just nicotine; just tetrahydrocannabinol (THC), which is the high-inducing chemical found in marijuana; and a combination of the two.

    Mitch Zeller, director of FDA's Center for Tobacco Products, said FDA's "laboratory analysis continues to show a mix of results. And there's no one compound, ingredient, constituent, including vitamin E acetate, that is showing up in all of the samples tested." He added, "We need to see what common threads emerge as we do the product analysis, as the interviews with the patients continue and as agencies at the federal and state level put their heads together and try to see what is the primary cause and what might the other causes be."

    FDA officials last month said they have found vitamin E acetate in many of the tested THC samples, and researchers have noted that the chemicals in vaping liquids "undergo thermal degradation" when they are heated, producing new, potentially harmful compounds.

    Jennifer Layden, Illinois' CMO, said state officials are hoping to collect more information about what is causing the illness from individuals who vape, but have not gotten sick. Layden said some of the patients who have been sickened with the illness are unable to speak with health care providers or officials because of the severity of their illness or a reluctance to discuss what illicit products they have used.

    CDC this week also activated the agency's Emergency Operations Center to help determine the cause of the illnesses. Schuchat said, "This is a complex investigation that spans many states and involves hundreds of cases and a wide variety of substances and products." Schuchat said public health officials are considering a number of hypotheses and it "may take some time" before they can find definitive answers. Schuchat said, "There may be a problem with source material or modification that may be occurring at different places" or "[t]his may turn into finding multiple issues that are of concern, rather than a single product or substance."

    FDA cracks down on illicit vaping products

    FDA officials this week also disclosed that investigators from the agency's enforcement arm, FDA's Office of Criminal Investigation, have been investigating the supply chain since officials reported the first lung illness case this summer.

    FDA's Office of Criminal Investigation oversees criminal investigations into illegal activities involving products regulated by FDA, arrests individuals involved in the activities, and then brings them before the Department of Justice to be prosecuted. FDA officials have said they are not prosecuting patients who have used controlled substances, including illicit marijuana, in an effort to ease the concerns patients who might be reluctant to share information with public officials.

    Zeller said, "The focus is on the supply chain. We're all alarmed by reports about THC-containing products," even if THC has not been involved in every case. Zeller noted marijuana is illegal in some states, which means some individuals have to purchase THC products "in an alley or on the street" (Sun, Washington Post, 9/19; Aubrey, "Shots," NPR, 9/19; Branswell, STAT News, 9/19; AP/New York Times, 9/19; CDC fact sheet, 9/19).

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